The Truth about "Use it or  Lose  it" | What to do When She Never Wants Sex | AMA

welcome to the Reena Malik MD podcast joined here with Reena Malik MD thank you for always providing us with great questions and ideas if you guys have any questions please leave it in the YouTube comments we do read the YouTube comments we do look for feedback great questions uh we do check the social media we do try to weed out the questions that come up often enough or anything that we find interesting that you guys want want to talk about so let's get into the first question so the question goes I don't know why my

wife doesn't want to have sex anymore I asked her and she's always not in the mood she's tired she's in a bad mood etc etc she's home all the time with kids so I'm not sure if the kids are giving her too much stress but she never wants to do it and I'm not sure if I can live like this I know this is not exactly a medical question because my penis works just fine but I think she needs to be seen by a doctor for this problem but I don't know what to do or

who who she should go see for this this is from Lao I don't want to give out the username Lao this is for this is what he's got going on what do you think doc so la this is so so common we see in people who are in long-term relationships particularly around midlife right your career is at its height usually you've got kids usually young kids they're taking demanding a lot of your time that can affect desire now I want to be clear here that this is an issue of mismatch desire you want sex and

she doesn't want it all the time right and if you're not having sex at all usually the definition of sexless marriage in terms of research is less than 10 times a year um what does that matter right it matters that you guys are on the same page right that you are both feeling that you are getting satisfied and you are happy and pleased with the situation now I don't want to say that your partner is the wrong one and you're the right one it's a relationship issue right it's an issue of you wanting it more

she wanting it less there's no right or wrong here right it's about finding what's right for your relationship so that you both compromise and make it work for you now what are some reasons that this happens well one is that as relationships are in long-term relationships you find that desire changes very often men continue to have this spontaneous desire where they see their partner they get turned or aroused and they want to have sex right and they don't have to like be in the right state of mind all the time and so that's sort of

what we see on TV right you see someone you're like so turned on and you immediately go and have sex with them right but that's not necessarily what happens in real life in real relationships now I don't want to generalize sometimes men don't feel this way but I will say more commonly men have spontaneous desire now women tend to have or develop responsive desire so what that means is they actually need to um sort of allow themselves to remind themselves what is g getting them turned on so for example when you are with your partner

you may like not be in the mood right away but you lie with them you snuggle with them you start touching them they start touching you and then they start feeling desire because like oh I used to like this like this is really fun it's actually making me turned on I actually now want to have sex but I didn't want to initially and so this is actually very common it is not a bad thing it's not something is wrong with you it's a matter of like how do we navigate this right so that you can

get to a point where you're both satisfied with how much sex you're having and so the one thing I talk to people is one of course you've got to decrease the stress in your life as much as possible like talk to her like what's going on in your life that is stressing you out and how can I help alleviate that stress and so you know there's all these joking Tick Tock of like men doing housework and women like this is how I get turned on right and I don't think it's that like men have to

do housework I think it's just feeling like you're getting supported or you're feeling like someone's trying to alleviate your stress so everyone is going to be different for for them what that is but you know figuring out a way to alleviate that or um if you can get help um and afford help getting help around the house or help with the kids or whatever it is um is going to be helpful and then the other thing is actually scheduling time for intimacy so we spend a lot of our lives like scheduling workouts scheduling you know

brunches with friends scheduling um meetings scheduling our kids activities whatever it is right but we don't ever prioritize our relationship like yeah we'll go on date night but is that intimate I don't know if that's really intimate enough right you're just having dinner you're having a meal together and you might be enjoying your time with each other but are you actually spending time that is meant for you to like enjoy each other right so it doesn't mean that you want to schedule like we're going to have sex at this moment and time on this day

because that can cause stress on both ends right it may cause stress in the person who has low desire because they're like I'm what if I don't want to and it may cause stress in the person with high desire because they may be like well what if I don't perform well at this exact moment at this exact time right and so ultimately you just want to say look we're just going to prioritize each other we're going to not eat first we're going to like lie down together take a bath together do something that's sort of

intimate whatever that is for you guys and it could be in a new location incorporate some novelty in there and we're not going to have any expectations but we're just going to prioritize each other we're not going to look at our phones we're not going to do other things we're going to be really in it with each other and continue doing that every so often and you could make little like homeworks out of it like today we're going to explore our bodies and not do anything sexual today we're going to like um you know try

this new thing and like if it doesn't work out like it's not the end of the world you just keep trying you keep prioritizing and eventually you can then reconnect well so the term is responsive intimacy desire resp responsive desire that's a good one I got to put that into the Google Calendar all right here we go all right next question after I pee in the toilet I still feel pee come out after I shake it like when I put it back in my underwear I still feel some pee come out how do I stop

this it happens too much this is from Deepu in India all right Deepu so this is called postvoid dribble or people call it after dribble and it is really annoying and I will tell you that you are not alone this is very very common and there's really like four major reasons that we see this happening so one is as men age men get a prostate that gets enlarged and so 80% of 80-year-olds will have an enlarged prostate and so you can imagine that as people age you're going to see more symptoms of enlarged prostate and

symptoms can be having trouble peeing um taking a long time you having your stream starts and stops um your stream is a little weaker than usual and feeling like you're not emptying completely it can also be things like going often got to go got to go or waking up at night very often to urinate and so one of the other symptoms of this is postvoid dribble and this can be because you have an enlarged prostate some of the urine doesn't get out but it does get into the P tube and so when you uh pee

it's not all empty all the way and then once you finish a little bit more dribbles out so sometimes treating that enlarged prostate can help another thing can be having uh a narrowing in that P tube or your rethal stricture now same as having an large prostate some urine can get stuck behind that narrowing which then dribbles out later another thing that we often see is sometimes having a weak pelvic floor or having muscles around the urethra um that are weaker can make it harder for you to completely sort of propel all that urine out

and then there's some left in the P tube that dribbles out later so you can do pelvic floor muscle exercises or keyle exercises to strengthen the pelvic floor and this can be sort of like as if you were trying to stop your stream when urinating now you don't want to do these while urinating but it's sort of how you learn what those muscles are you don't want to squeeze your abdomen you don't want to squeeze your bottom you just want to squeeze those muscles in the pelvic floor and and hold them for about 5 seconds

and then relax for 5 seconds you can also sort of like uh as if you were trying to lift your penis off the ground without actually touching your penis or like holding in a fart so those are sort of ways that you can help yourselves find those muscles and then use them to strengthen the pelvic floor and may that may help you with the dribble you can also sort of milk the urine out so you can that same area of the perineum we talked about earlier you can can actually like push use two fingers to

like push urine out and hopefully that will help get some of that urine out as well otherwise just shake it and hopefully you'll be okay just shake it I like it got to shake it out guys um so that that question actually does come up quite often in the comments uh I know you did put out a video so please do check that out all right next question should I be using a special soap for my vagina to clean it I had a time when a guy didn't go down on me cuz he said it

smelled a bit and ever since I've been self-conscious of this when someone wants to have oral sex with me Ms that's the initials okay so one I will just say that women have been marketed to about vaginal odors and made to feel like their vagina needs to smell like a pina colada or like peaches or like keyme pie I don't know whatever it doesn't need to do any of that so your vagina has a natural odor to it that actually has pheromones that actually can be um sort of arousing to your partner so as long

as you're not having infections you're not having other issues it can actually be a fine and actually nice smell for your partner now you don't need a special soap to clean the vagina now the vagina is the internal part and that you don't need to put soap in or water in fact if you do that you may disrupt the microbiome or the normal good healthy BAC acteria in that area so you don't want to use soap there you don't want to take the shower head and put it in the you know up there like you

don't need to do any of that what you do need to do is have soap and gentle sensitive skin soap and put it on the hair bearing area so the mons which is at the top part of the uh the vulva and then on the sides where there's hair bearing areas you can wash the hair because that can get sweaty and and have an odor to it so you want to keep that area clean but the vagina itself is a selfcleaning oven and so you don't need do anything for that because the more you do

in fact the more harm you may do to yourself so don't buy any products that you know you need to clean in the vagina or anything like that just plain old simple sensitive skin soap on the hair bearing areas keep it natural self-cleaning I like that wish my house was self-cleaning um me too so next question is from Melinda my boss is always complaining how often I P I have to leave the register register to do this which means he needs to cover the register I think he's just lazy but I usually just drink a

couple of cups of coffee at work so it's not like I'm drinking a gallon of water or anything like that I'm only 36 so I can't be having peeing problems this early in life right all right sounds like she's going very frequently she's 36 she's at work maybe she's on her feet I don't know a couple of cups of coffee it sounds like nothing crazy boss is not happy with her frequent bathroom breaks thanks for that summer yeah so sounds like sounds like she has urinary frequency so urinary frequency is typically one of the symptoms

of what we call overactive bladder so overactive bladder can be um urinary frequency are going more than eight times a day urinary urgency like having the strong desire to go to the bathroom that you can't delay urgency in continence so leaking urine because you can't make it to the bathroom in time and then noctua are waking up at night to urinate often first things when you have these issues we want to rule out anything that might be causing these issues which could be like having a blockage so for women sometimes it can be having prior

surgery in that area that could have blocked up the P tube a little bit so that urine doesn't come out as easily can cause overactive bladder it can also be from neurologic causes so if you have something like multiple sclerosis or other neurologic conditions like Parkinson's disease uh which is usually seen in older people um these sorts of things can really affect your bladder function um and then in men we often see these symptoms in relation to an enlarged prostate which we talked about earlier so one we want to rule out all those things and

make sure she's emptying her bladder well so sometimes we'll find also in these patients that their bladder is not emptying well particularly if they do a job where they are standing all day and they can't go like for or they've held their urine for um hours at a time even since they were a young kid over time their bladder can get stretched out and and not function as well not squeeze as well to empty the bladder and that can then result in your blad not emptying so you're having a lot more urine in your bladder

at all times and so your blad is having these spasms tell hey you got to go you got to go you got to empty this urine so now what can you do about it so first off you know again evaluate for all these things the other thing that sometimes comes up is pelvic floor dysfunction so having tense pelvic floor muscles which can occur due to stress trauma anxiety um just any sort of Life stressors right we often see it in type A personalities or people who have a lot of Life stressors that they are tensing

up their pelvic floor and they don't really know why they're doing it or that they're doing it at all it's sort of like TMJ when you go to sleep at night and you grind your teeth because you're you're you're getting tense in your jaw and you don't know it and uh it's the same thing your body is sort of having this reaction and these muscles will then sort of activate the pelvic flow activate the bladder and feel like it has to go even though the bladder is really mostly empty so first things first get a

value by urologist um second thing I would say is what can you do to to try to fix this at home so I've made a whole video on this but basically you want to watch what you're drinking you don't want to drink too too much cuz you're just going to go more right so if you're drinking a gallon a day to lose weight but you're going to the bathroom every 5 minutes then you got to cut back on how much you're drinking if you are drinking too little because you're peeing so much actually that concentrated

urine will irritate the bladder and make you feel like you have to go more often so it's important to drink enough so I tell people look at the color of your urine if it's a lemonade yellow color you're doing good if it's darker than lemonade yellow dark yellow dark orange too dark and you need drink more if it's clear you're drinking too much and you need to drink a little less um so that's number one number two is make sure you're avoiding bladder irritants now bladder irritants can be a whole host of things this can

include caffeine alcohol those are the two big ones she's only drinking a couple cups of coffee but I don't know how big those cups are if she's having those big 32 o Dunkin Donut coffees that's a lot of caffeine those are big yeah so you got to be careful um and then and uh depending on um other things so some people are really sensitive to citrusy fruits some people are sensitive to Tomato based products some people are sensitive to artificial sweeteners or carbonated beverages so I'm not saying you got to get rid of all these

things because it's basically everything that's delicious in life but um sort of like take one thing out of the equation for a couple days and see if it makes a difference and then making sure you're not constipated because constipation and I will tell you I just had two patients today who both had no idea that they're constipation a was causing their bladder problems we sent them to the gastroenterologist they got their constipation under control and now their bladder symptoms are way better so it's because right it's space occupying the rectum is behind the bladder and

when it gets full of stool it's pushing against the bladder and it makes everything a lot worse and then um weight loss can help we know that if you are overweight and you lose 8% of your body weight that you will have a significant reduction in urinary symptoms so these are all things you can work on at home and then there's whole host of things that we can offer you as doctors that can help very helpful very helpful who knows Melinda your boss might be lazy after all you don't know but uh that's very helpful

all right this is from E Graham he writes can I get erectile dysfunction by not having sex with a woman for many years so sounds like hasn't been intimate in a while what do you think you mean like use it or lose it use it or L I think that's what he's getting that's wow we got to put that on a t-shirt somewhere so the body has a really great way of sort of maintaining good blood flow to the genitals even when you're not having sex so yes ideally you're having sex you're getting good blood

flow to the genitals very frequently and that helps right maintain good blood flow and good tissue Health you need good blood flow to make make sure that those tissues are healthy but you may know this that you wake up with a erections right and if you're waking up with erections you are also having erections at night usually anywhere between 3 to six times at night your body will have an erection and women's clitorises will Tess or get erections as well and so that's your body's way of physiologically getting more blood flow to those tissues and

making sure that your your organs stay very healthy now the number one reason that people get erectile dysfunction as they age is because of blood flow problems it's not because they didn't have sex enough it's because they have high blood pressure diabetes high cholesterol or other vascular problems that will affect blood flow to the penis they can also develop neurologic problems they can get prostate surgery they can take medications that can affect sexual function or they can have low testosterone it's usually a smaller subset of people who get erectile dysfunction just from low testosterone but

all of those things combined are usually the number you are us causing issues with erectile dysfunction and so yeah if you're unwell and unhealthy like someone who's not had sex for many years it may be because they're not as healthy as the person who is having sex throughout many many years ultimately it's not because you're not using it your body will take care of you even if you're not having sex but it's more about making sure you maintain your health so exercise regularly eat right and these things will pay you dividends years and years later

all right all right let's pull up the the next one this is coming from our member one of our subscribers all right prepare yourself so it's uh it sounds like it's a fetish question why is a woman's anal opening erotic to me as I love anal licking from no name but uh from one of our subscribers yeah so you know the reason people find certain things attractive can be of variety of different things it can be that it's sort of an off limits area for most people and that can be arousing it can be that

maybe he's had some good experiences early on in life with anal play or anal sex and so he now finds that very erotic and again it is is not a bad thing it's not abnormal there's no like one specific reason why people find certain things attractive to them as long as you're having sex that is safe consensual and that is in a safe place um it is totally fine to pursue any sort of fetish or Kink as long as you're not harming yourself or harming others and so I think the more important thing is if

that's what you're into and you're partner good with it by all means go ahead and um as long as you're doing it you know in a safe place thank you guys so much for joining us for today's ama if you want to hear the rest of the questions from our members join our exclusive exive membership at renam malik. supercast dcom where you can be an exclusive member you will have Early Access to all of our YouTube podcasts video and audio ad free and you will get the opportunity to ask me anything and your questions will

be prioritized for all of these episodes in the AMA and you will get the full AMA episode so check it out and as always we going to take care of yourself because you're worth it